Last night's shift was one of those where you look back on it and say, "Seriously? Did that really happen??" Mr. M had been slightly confused and attempting to get up and wander around during the day so at night we turned on the bed alarm so we would know when he tried to get up. The alarm went off no joke, every 15 minutes. At 11pm he ran down the hallway to the back stairwell trying to escape. At that point the nurse gave him some Ativan to help calm him down, and it worked for a tiny bit. At quarter to 12 he got up out of bed and walked over to the window to "try to escape." We got him back in to bed and thats when things got a little crazy. He started hallucinating and because of it, was swatting at us. We tried to calm him down and reorient him, but nothing worked. He was getting more and more agitated so we paged the doctor. No response. Vitals were stable, but he was just SO confused. There were times where you could reorient him, but for the most part he was mumbling nonsense. Pupils were unequal, but reactive. The patient started swatting and throwing things so much that we just ordered the restraints. when the MD finally returned the page, we had 3 nurses and a tech in the room trying to hold the patient down. The doctor took a quick glance at him and said, "ok, give 5mg Haldol." We gave the Haldol, nothing. We gave another Haldol but then realized that the IV was infiltrated, so we gave Haldol IM. Still Nothing. The doctor ordered to get labs and an IV. Hey doc, how the F are you gonna get labs and put an IV in a combative, flailing patient. At this point security was there helping us. Nothing was working for the guy. The MD didnt order anything, he didnt even go in and assess the patient! He was worthless. He continued to thrash for the next 3 hours. We gave Mr. M a total of 20mg of Haldol and 15mg of Morphine and nothing was affecting him. It was absolutely ridiculous. In the morning he actually got worse and we had to call up 4 security guards to get him under control and we put him in 4-point restraints. When the other residents came in, the R4 looked at the doctor who was on last night and asked him why he never ordered a Neuro consult. ...b/c he's an idiot. Nothing too alarming medically since the patient was hemodynamically stable, but he was just SO agitated and so confused. The resource nurse said he's probably encephalopathic but I've never seen encephalopathy present like that. Confusion and anxiety, yes. But there was definitely something else going on.
It was just the most ridiculous shift. I cant believe the doctor on call didnt do anything. He literally never even went in past the door frame of the patient's room. I was so frustrated with him and I wasnt even the nurse for that patient. Thank goodness the rest of our patients were stable! We were able to spend most of our time in with that one patient. None of us got a break during the night AND we didnt leave till 9am. Ridiculous. Not in the sense that my patients were unstable, but everyone was just in disbelief of what was going on and how crazy the patient was. Oh fun times. :)
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